Massive rectal bleeding from a superior mesenteric artery pseudoaneurysm successfully managed by coil embolization in an HIV-positive patient with disseminated tuberculosis: a case report.

Gastrointestinal bleeding is a rare manifestation of intestinal tuberculosis, with massive hemorrhage from a mesenteric artery pseudoaneurysm representing an exceptionally uncommon and life-threatening complication. As illustrated by the case of a 27-year-old male with newly diagnosed HIV (CD4 count 10 cells/mm3) who presented with a 3-month history of diarrhea, fever, and significant weight loss. This led to a confirmed diagnosis of disseminated tuberculosis. On day 5 of anti-tuberculosis treatment, the patient developed massive hematochezia, and abdominal computed tomography (CT)-angiography followed by diagnostic arteriography identified a pseudoaneurysm of the appendicular branch of the ileocolic artery, which was successfully embolized with coils. This resulted in immediate hemostasis and stabilization of the patient, allowing for the initiation of antiretroviral therapy one month later. This case demonstrated that angioembolization is a highly effective and minimally invasive therapeutic alternative to surgery for this critical condition, even in immunocompromised patients.